Rotational thrombectomy wire

ABSTRACT

A rotational thrombectomy wire for breaking up vascular thrombus or other obstructive material having a core having a proximal portion and a distal portion. The distal portion has a smaller diameter than the proximal portion. A cable extends distally of the core. The cable has a first covering material positioned external thereof. A first coil is attached to a distal portion of the cable and has a diameter larger than a diameter of the cable and has a second covering material positioned thereover. The wire is rotatable by a motor.

This application is a divisional of co-pending U.S. application Ser. No.13/095,329, filed Apr. 27, 2011 which claims priority from provisionalapplication Ser. No. 61/334,412, filed May 13, 2010. The entire contentsof each of these applications are incorporated herein by reference.

BACKGROUND

Technical Field

This application relates to a rotational thrombectomy wire for clearingthrombus from native vessels.

Background of Related Art

There have been various attempts to break up clots and other obstructingmaterial in grafts or native vessels. One approach is through injectionof thrombolytic agents such as urokinase or streptokinase. These agents,however, are expensive, require lengthier hospital procedures and createrisks of drug toxicity and bleeding complications as the clots arebroken.

Other approaches to breaking up clots involve mechanical thrombectomydevices. For example, U.S. Pat. No. 5,766,191 discloses a cage or basketcomposed of six memory wires that expand to press against the innerlumen to conform to the size and shape of the lumen. This multiple wiredevice is expensive and can be traumatic to the graft, possibly causingdamage, since as the basket rotates, the graft is contacted multipletimes by the spinning wires. Other risks associated with the basketinclude the possibility of catching onto the graft itself and tearingthe graft as well as catching and tearing the suture at the anastomoticsite. Additionally, the basket can become filled with a clot which wouldthen require time consuming withdrawal of the basket, cleaning thebasket and reinserting it into the lumen. This device could be traumaticif used in the vessel, could denude endothelium, create vessel spasmsand has the potential for basket and drive shaft fracture.

U.S. Pat. No. 6,090,118, incorporated herein by reference in itsentirety, discloses a wire rotated to create a standing wave to break-upor macerate thrombus. The single wire is less traumatic than theaforedescribed basket device since it minimizes contact with the graftwall while still effectively mechanically removing thrombotic material.

U.S. Pat. No. 7,037,316 discloses another example of a rotationalthrombectomy wire for breaking up clots in grafts. The thrombectomy wirehas a sinuous shape at its distal end and is contained within a sheathin a substantially straight non-deployed position. When the sheath isretracted, the distal portion of the wire is exposed to enable the wireto return to its non-linear sinuous configuration. The wire is composedof two stainless steel wires wound side by side with an elastomeric tipat the distalmost end. Actuation of the motor causes rotational movementof the wire, creating a wave pattern, to macerate thrombus. Thus, itprovides the additional advantages of increased reliability andconsistency in creating the wave pattern since the wave pattern createdby the standing wave of the '118 patent will depend more on therotational speed and the stiffness of the wire. Additionally, thesinuous configuration enables creation of a wave pattern at a lowerrotational speed.

Although the sinuous wire of the '316 patent is effective in properclinical use to macerate thrombus in dialysis grafts, it is not bestsuited for use in native vessels. U.S. Pat. No. 7,819,887, (PublicationNo 2006/0106407) the entire contents of which are incorporated herein byreference, discloses a thrombectomy wire better suited for use in nativevessels (and can also be used for deep vein thrombosis and pulmonaryembolisms).

In neurovascular thrombectomy procedures, the thrombectomy wire needs tonavigate small tortuous vessels. That is, the wire is inserted throughfemoral artery and then must navigate small and tortuous vessels as itis advanced to the smaller cerebral arteries of the brain. Within thebrain, the carotid and vertebrobasilar arteries meet to form the circleof Willis. From this circle, other arteries, e.g., the anterior cerebralartery, the middle cerebral artery and the posterior cerebral artery,arise and travel to various parts of the brain. Clots formed in thesecerebral arteries can cause stroke and in certain instances death of thepatient.

Due to the size and curves of the vessels en route to the cerebralarteries from the femoral artery, as well as the size and structure ofthe cerebral arteries themselves, access is difficult. If thethrombectomy device is too large then navigation through the smallvessels, which can be as small as 1 mm, would be difficult. Also, if thedevice is too stiff, then it can damage the vessel walls duringinsertion. On the other hand, if the device is too flexible, it willlack sufficient rigidity to be advanced around the vessel curves and canbe caught in the vessel. Consequently, it would be advantageous toprovide a thrombectomy device for breaking cerebral clots and otherobstructing material that strike the optimal balance of flexibility andstiffness, thus effectively having the insertability of a trackingguidewire while enabling high speed rotation to effectively macerateclots or other material without damaging vessels.

It would also be advantageous in certain instances to provide aseparable thrombectomy wire and motor for connection by the user, whichcan ease insertion of the wire and enable replacement of differentmotors and/or batteries.

SUMMARY

The present invention advantageously provides in one aspect a rotationalthrombectomy wire for breaking up vascular thrombus or other obstructivematerial. The wire comprises a core having a proximal portion and adistal portion, the distal portion having a smaller diameter than theproximal portion. A cable extends distally of the core and has a firstcovering material positioned external thereof. A first coil is attachedto a distal portion of the cable, the first coil having a diameterlarger than a diameter of the cable and having a second coveringmaterial positioned thereover. The wire is rotatable by a motor.

In one embodiment, the first coil has a sinuous shape. In anotherembodiment the first coil has a J-tip.

In some embodiments, a second coil is positioned over a region of thedistal portion of the cable.

In some embodiments, the cable has multiple layers of polymeric materialpositioned thereover, wherein the layers create a larger diameterproximal region. The cable can have variable stiffness such that adistal portion of the cable has a lower stiffness than a proximalportion. A hypotube can be provided to couple the cable to the core.

In some embodiments, the wire has a connector at a proximal portion forconnection by the user to a handle containing a motor.

In another aspect, the present invention provides a thrombectomyapparatus for breaking up vascular thrombus or other obstructivematerial comprising a wire having a core having a proximal portion and adistal portion. The distal portion has a smaller diameter than theproximal portion. A cable extends distally of the core. A first coil isattached to the distal portion of the cable. The first coil has adiameter larger than a diameter of the cable and has a first coveringmaterial positioned thereover. The wire is rotatable by a motor. Ahousing contains a motor to rotate the wire. The wire is connectable tothe motor by the user.

The apparatus can include an adjustment mechanism to adjust the speed ofthe motor. A gear reducer can be connected to the motor and a couplingtube can extend from the gear reducer to detachably connect thethrombectomy wire to the motor.

In some embodiments, a hypotube can connect the cable to the core.

In some embodiments, the wire is connectable to the motor coupler by abayonet connector; in other embodiments it is connectable to the motorcoupler by a friction fit.

In some embodiments, the apparatus includes a sheath extending from thehousing and slidable between a distal position to cover the first coilto a proximal position to expose the first coil.

In another aspect, the present invention provides a method for removingthrombus in a cerebral artery of a patient comprising the steps of:

introducing a guidewire into the femoral artery;

inserting the guidewire through the vascular system in the cerebralartery;

inserting a catheter tube over the guidewire into the cerebral artery;

removing the guidewire;

placing an introducer at the proximal end of the catheter tube;

inserting a thrombectomy wire through the introducer and into thecatheter tube, the thrombectomy wire having a coiled tip with a coveringthereover;

advancing the thrombectomy wire to the cerebral artery;

operatively coupling a motor to the proximal end of the thrombectomywire; and

activating the motor to rotate the thrombectomy wire to maceratethrombus in the cerebral artery.

In one embodiment, the step of inserting the thrombectomy wire to thecerebral artery includes the step of inserting the thrombectomy wireinto the circle of Willis.

BRIEF DESCRIPTION OF THE DRAWINGS

Preferred embodiment(s) of the present disclosure are described hereinwith reference to the drawings wherein:

FIG. 1 is a perspective view of a first embodiment of a thrombectomyapparatus of the present invention;

FIG. 2 is an enlarged perspective view of the housing of the apparatusof FIG. 1;

FIG. 3 is a longitudinal cross-sectional view of the housing of FIG. 2;

FIG. 4 is an enlarged view of the distal portion of the thrombectomyapparatus of FIG. 1;

FIG. 5 is a longitudinal cross-sectional view of the apparatus shown inFIG. 4;

FIG. 6 is a perspective view of an alternate embodiment of thethrombectomy apparatus of the present invention having a curved tip;

FIG. 7 is a perspective view of another alternate embodiment of thethrombectomy apparatus of the present invention having a sinuous tip;

FIG. 8 is a perspective view of an alternate embodiment of the handleportion of a thrombectomy apparatus;

FIG. 9 is a cross-sectional view illustrating connection of thethrombectomy wire to the handle portion of FIG. 8 in accordance with oneembodiment of the present invention, the handle shown in cross-section;

FIG. 9A is a cross-sectional view similar to FIG. 9 showing an alternateembodiment of a connector for the wire and handle portion;

FIG. 10 is an anatomical view showing select cerebral arteries;

FIG. 11 is a front anatomical view showing select cerebral arteries,including the circle of Willis;

FIG. 12 illustrates insertion of an introducer sheath through thefemoral artery and into the cerebral artery over a tracking guidewire;

FIG. 13 illustrates insertion of the thrombectomy apparatus through theintroducer sheath and into the circle of Willis; and

FIG. 14 illustrates continued advancement of the thrombectomy wire ofFIG. 13 to deploy the distal portion of the wire in the circle ofWillis.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

Referring now in detail to the drawings where like reference numeralsidentify similar or like components throughout the several views, FIG. 1illustrates a first embodiment of the thrombectomy apparatus of thepresent invention.

The thrombectomy apparatus of FIG. 1 is designated generally byreference numeral 10. The apparatus includes a housing 12 and arotational thrombectomy wire 30 extending therefrom.

As discussed below, the apparatus can be inserted into a separateintroducer sheath to shield the distal end portion of the wire 30 duringinsertion. Alternatively, the apparatus can include a sheath (not shown)extending from the housing 12 which is movable between a distal(advanced) position to cover the distal tip portion of the thrombectomywire 30 and a proximal (retracted) position to expose the distal tipportion of the wire 30. In this version, a knob on housing 12 isoperatively attached to the flexible sheath to enable sliding movementof the flexible sheath (tube) with respect to the wire 30, and can alsoprovide rotation of the sheath. The flexible sheath can be slidable andthe wire fixed axially, alternatively, the wire can be axially slidablewithin the stationary sheath, or both the wire and sheath can beslidable. In any case, such relative movement of the wire and sheathwill enable the wire 30 to be exposed to enable removal of obstructions,such as blood clots, from the lumen of the vascular structure. The useof such sheath is also applicable to the other wires disclosed herein.An example of a slidable sheath to cover and uncover a thrombectomy wireis disclosed in U.S. Pat. No. 7,037,316, the entire contents of whichare incorporated herein by reference.

It is also contemplated that the thrombectomy wire 30 (as well as theother wires disclosed herein) can be a separate component/assemblyinsertable into a separate sheath component/assembly either prior toinsertion into the body or after the sheath is already placed in thebody. In the latter, the sheath can be inserted with a placement(tracking) guidewire and then the placement guidewire removed forinsertion of the thrombectomy wire 30 into the already placed sheath.This is the version shown in FIG. 1.

Turning to the housing or handle portion 12, and with reference to FIGS.1-3, contained within housing 12 is a motor 52, a gear reducer 54, and abattery 56, such as a 3 Volt battery, for powering the motor 52. Thebattery 56 can be contained within a compartment in the housing 12accessible by removing a battery door. A coupling tube 64 is connectedto the speed reducing gear 54 for connection to a proximal end 31 of thethrombectomy wire 30. The gear reducer by way of example can reduce therotational speed of the motor 52 from 15,000 rpm to 1500 rpm, 750 rpm,150 rpm, etc. When the motor 52 is energized, the support or couplingtube 64 is rotated about its longitudinal axis, via rotation of a chuckdriven by gears, thereby rotating the wire 30 about its longitudinalaxis. A potentiometer 57 is wired to the motor to enable dialing themotor speed up or down to adjust the rotational speed of thethrombectomy wire 30 to adjust for various procedures and/or clotlocations and sizes. In a preferred embodiment, the potentiometer isused as a two terminal variable resistor, i.e. a rheostat, by notconnecting the third terminal. In this manner, in the initial position,the motor speed is at the desired minimum and rotation of a knob 57 (orin alternate embodiments sliding of a knob or actuation of another typeof actuator) progressively increases the motor speed. An on/off switch58 extending from the housing 12 is electrically connected to the motor52 to turn on the motor 52 to activate the apparatus, i.e. rotate thewire 30.

Further details of the internal components which can be utilized toconnect and rotate the wire are illustrated and described in U.S. Pat.No. 7,037,316, the entire contents of which have already beenincorporated herein by reference. Such arrangements can also be used toconnect and spin the thrombectomy wire of the other embodimentsdisclosed herein.

The housing 12 in alternate embodiments can be a separate unitattachable to the wire by the clinician. In such embodiments, it can bedetachably connected to the thrombectomy wire, and alternatively in someembodiments it can be configured for permanent attachment once connectedby the clinician. The detachable connection is shown in FIGS. 8 and 9.Apparatus 100 is identical to apparatus 10 except for the connection ofthe proximal end 131 of wire 130 to the housing 112. That is, therotational thrombectomy wire 130, either after insertion to the surgicalsite or prior to insertion, is attached by a clinician at a proximal end131 to coupler tube 164 which is connected to gear reducer 154. Motor152 is within housing 112. The connection of wire 130 can be for examplea friction fit as shown in FIG. 9 or a twist connect, e.g. a bayonetconnection as shown in FIG. 9A, by way of example. In the frictionmount, the O-ring 139 of wire 130 is seated within O-ring recess 137 aof housing recess 137. In the bayonet mount, like components to FIG. 9are labeled with “prime” designations, e.g. coupler tube 164′, gearreducer 154′, housing 112′, motor 152′ etc. The pin and slot aredesignated by reference numerals 142′, 144′, respectively; pin 142′extending in housing recess 137′ and slot 144′ formed in proximal end131′ of wire 130′. Note other connections are also contemplated. Theseattachable connections can ease insertion of the wire as the wire 130(and 130′) can be inserted in a similar manner as a tracking guidewire(without a handle) and then the handle (housing) 112 (or 112′) attachedafter insertion of the wire 130 (or 130″). Insertion without a handlecan aid introduction and manipulation of the wire since it is lesscumbersome and of lighter weight than if the motor housing was attachedduring manipulation of the wire. Additionally, by having a detachablehousing 112 (or 112′), different handles with different motor speedsand/or different batteries can be utilized by attachment to the wire 130(or 130′). This can even be achieved during the same surgical procedure.Such connections can also be used for detachable connection of wires 260and 360.

In some embodiments, the housing can be detached, sterilized and reusedafter recharging of the battery or replacing the battery.

It is also contemplated that as an alternative to a removableattachment, in certain embodiments, once attached, the wire and housingcan be non-detachable (inseparable) from each other.

Housing 112 of apparatus includes knob 157 and switch 158 for actuatingmotor 152 which are identical to knob 57 and switch 58 of FIG. 1.

FIGS. 1, 4 and 5 illustrate the thrombectomy wire 30 (wire 60) with adistal coiled tip 90 substantially aligned with the longitudinal axis ofthe apparatus during both insertion and use. In alternate embodiments,the distal coiled tip is angled with respect to the longitudinal axisand thus has a non-linear configuration. For example, in FIG. 6, thewire 360 forms a J-tip which creates a standing wave upon rotation. Inthe embodiment of FIG. 7, the wire 260 forms a substantially sinuousshape, resembling a sine curve. These various tips are discussed in moredetail below.

As noted above, these various thrombectomy apparatus disclosed hereincan be provided without a sheath and inserted into an already placedsheath in the body or inserted into a sheath and then together insertedin the body. However, it is also contemplated that a sheath can beprovided as part of the apparatus, operatively attached to and extendingfrom the housing (12, 112 or 112′), to slide to cover and uncover(expose) the distal tip of the wire.

In the embodiments wherein a sheath (flexible tube) is connected to thehousing and is slidable with respect to the housing 12 (or housing 112or 112′) and the thrombectomy wire, the flexible tube can also berotatable. Sliding movement of a control mechanism such as a knobaccordingly slides the flexible tube axially and rotation of the controlmechanism (or a separate mechanism) accordingly rotates the flexibletube about its longitudinal axis. Sliding movement of the controlmechanism exposes the rotational wire, and in the non-linear distal tipembodiments, enables the distal tip of the wire to assume its curved(non-linear) configuration of FIG. 6 or 7. Rotation of the knob can beused for example to orient the rotational wire of FIG. 6 due to theJ-shaped distal end.

The flexible sheath or tube can optionally contain one or more braidedwires embedded in the wall to increase the stiffness. Such braided wireswould preferably extend the length of the sheath, terminating proximalof the angled tip.

In the embodiment with a sheath (flexible tube), an extension arm of aTouhy borst can be provided positioned within housing 12 (or 112, 112′)having a lumen communicating with the lumen of the flexible sheath.Fluids such as imaging dye can be injected through the arm, flowingthrough the sheath in the space between the wire and the inner wall ofthe sheath, and exiting a distal opening to flow into the vessel. Thisimaging dye can be used to provide an indication that fluid flow hasresumed in the vessel. The Touhy can contain a conventional siliconegasket which is compressed when tightened to provide a seal to preventback flow of fluid around the support tube. An example of such extensionarm is disclosed in U.S. Pat. No. 7,037,316, the entire contents ofwhich are incorporated herein by reference. Suction can also be appliedin the space between the wire and the inner wall of the sheath.

With reference to FIG. 6, the wire 360 terminates in a J-tipconfiguration at distal tip 376. Due to this angle, when the wire isrotated by the motor at sufficient speed at least one vibrational nodeis formed. Details of this creation of a standing wave are described inU.S. Pat. No. 6,090,118, the entire contents of which are incorporatedherein by reference.

Wire 260 of FIG. 7 has a substantially linear portion extending throughmost of its length, from a proximal region, through an intermediateregion, to adjacent distal region 276. At the distal region 276, wire260 has a sinuous shape in that as shown it has a first arcuate region263 facing a first direction (upwardly as viewed in the orientation ofFIG. 7) and a second arcuate region 265, spaced longitudinally from thefirst arcuate region 263, facing a second opposite direction (downwardlyas viewed in the orientation of FIG. 7). These arcuate regions 263, 265form “peaks” to contact vascular structure as the wire 260 rotates.These peaks 263, 265 can be equal (symmetric) or of different heights,e.g. peak 265 extending a further distance from a longitudinal axis thanpeak 263. This distal portion 276 includes a coiled portion with acovering material to block the interstices of the coil similar to thecovered coil of wire 60 discussed below.

When the wire 260 is fully retracted within the sheath (either theintroducer sheath or in other embodiments within the sheath extendingfrom the apparatus housing), the curved regions of the wire 260 arecompressed so the distal region 276 is contained in a substantiallystraight or linear non-deployed configuration. This covering of the wire260 facilitates insertion through an introducer sheath and manipulationwithin the vascular structure. When the flexible sheath is retracted byproximal axial movement, or the wire is advanced with respect to thesheath or both are moved with respect to each other, such relativemovement causes the distal region 276 of the wire 260 to be exposed toenable the wire 260 to return to its non-linear substantially sinuousconfiguration shown in FIG. 7 for rotation about its longitudinal axiswithin the lumen of the vessel. Note that the term relative movement ofthe sheath and wire encompasses movement of one of these components orboth of these components.

In an embodiment of the coiled tip being composed of shape memorymaterial, the memorized configuration is sinuous or S-shape as in FIG. 7or J-shaped as in FIG. 6. In the softer state within the sheath, thewire is in a substantially linear configuration. This state is used fordelivering the wire to the surgical site. When the wire is exposed towarmer body temperature, the tip transforms to its austenitic state,assuming the S-shaped memorized configuration. The coiled tip canalternatively be a radiopaque coil/polymer pre-shaped to an “S”.

Details of the wire 60, which corresponds to wire 30, will now bedescribed with reference to FIGS. 1-5. These details are the same forwire 130 and 130′ of FIGS. 9 and 9A, the only difference being itsproximal end connection to the motor coupler. These details are also thesame for wires 260 and 360, the only difference being that instead ofthe distal coiled tip being substantially straight (linear) in thedeployed position, the distal tips are curved in a sinuous configurationor a J-configuration, respectively, and their overall lengths maydiffer. For convenience, details will be discussed with reference towire 60. Like components in wires 260 and 360 to wire 60 are labeled inthe “200 series” and the “300 series”, respectively, for convenience.Note the distal coil of wires 260 and 360 underlies the coveringmaterial 287, 387, respectively, which blocks the interstices.

Wire 60 has a core 62 having a proximal portion 64 and a distal portion66. Transition region 68 is tapered distally so that the diameter of thedistal portion 66 of core 62 is less than the diameter of the proximalportion 64. In one embodiment the core is a solid material made of anickel titanium alloy, although other materials are also contemplated.The core can also be formed from a hypotube with a tapered bodyattached, e.g. welded, to the distal end of the hypotube. Distally ofthe taper 68, the core can have a uniform diameter portion extendingdistally thereof.

Overlying distal portion 66 of the core 62 is coil 70, preferablycomposed of stainless steel, although other materials are contemplated.This coil functions to increase the diameter to increase the torsionalstiffness/rigidity of the wire for pushability.

The core 62 is tapered to accommodate connection to cable 80. Hypotube72 is positioned over the distalmost end of the core 62 and is attachedthereto by a number of methods, including but not limited to, solderingwelding or crimping.

Extending distally from hypotube 72, and attached thereto, is a cable80. Thus, hypotube 72 is positioned over a proximal portion of cable 80,and functions to couple the cable 80 to the core 62. A distal coil 90 isattached over a distal end of cable 80. The cable 80 in one embodimenthas a variable stiffness such that the proximal portion 82 is stiffer,e.g. has a tighter braid, than a distal portion 84 to increase theflexibility of the distal portion 84. Various covering materials, e.g.coating, jackets and/or shrink wraps, can be used as an alternative orin addition to vary the stiffness of the cable 80. A polymer coating(s)and/or jacket(s) can be placed external of the cable 80. That is, it canbe placed over at least a portion of the cable 80 to cover theinterstices in the cable 80. In one embodiment, a urethane jacket 88 isplaced over the cable 80, a PTFE jacket 87 is placed over the urethanejacket 88, and a Pebax jacket 89 is placed over the jacket 88 at aproximal portion of the cable 80, underlying the PTFE jacket 87 andoverlying jacket 88. In this manner, the cable 80 is “beefed up” at aproximal portion to provide a smoother transition from the hypotube 72which is of larger diameter as well as to increase the stiffness of thecable 80. Note the coating or jacket 87 can extend to the distalmost endof the wire 60, extending along the length of the cable 80 and coveringthe distal surface of the coiled tip 90 as shown at region 83. Thedistal end of the jacket 88, in the illustrated embodiment, terminatesproximally of coil 90 and thus extends only over a portion of cable 80.The jacket 87 or another covering material can optionally be placed overthe hypotube 72 and proximal coil 70.

In an alternate embodiment, the PTFE jacket 87 is positioned over thedistal end of the cable 80 and over the distal coil 90, but not over theproximal region of the cable 80. By way of example, the PTFE jacket 87can extend for about 6 inches, although other lengths are contemplated.A Pebax, Nylon or other material can be placed over the proximal portionof the cable 80 and over the hypotube 72 and proximal coil 70 which ispositioned over the reduced diameter portion of the core 62 (proximal tohypotube 72).

Coil 90, forming a coiled tip, is positioned over a distal tip of thecable 80. In one embodiment, the coiled tip 90 has a linearconfiguration in the deployed/uncovered position (see FIG. 1). In analternate embodiment, the coiled tip has a J-tip configuration, as shownfor example in FIG. 6. In another embodiment, shown for example in FIG.7, the coiled tip has a substantially sinuous configuration. In each ofthese embodiments, a covering such as a jacket, shrink wrap or coatingpreferably covers the coil such as the coverings described above. Theother coverings described above are also applicable to these wires.

By way of example only, the components of wire 60 can have theapproximate dimensions set forth in the table below. It should beunderstood that these dimensions are provided by way of example as otherdimensions are also contemplated. These are also approximate values.

APPROXIMAT OUTER APPROXIMATE COMPONENT DIAMETER LENGTH Core 62 (proximalnon .016 inches 139.5 cm tapered portion) Core tapered portion .016inches to .0095 inches 11.7 cm Proximal coil 70 .016 inches 4.4 cmHypotube 72 .013 inches .2 cm Cable 80 .006 inches 39.2 cm Jacket 88.002 inches 15.3 cm Jacket 87 .0017 inches  39.2 cm Jacket 89 .002inches 9 cm Distal coil 90 .013 inches 1.2 cm

The covering material, e.g. coating, jackets, and or shrink wraps, helpsto prevent bending or knotting of the wire which could otherwise occurin native vessels. The covering also increases the torsional strength ofthe wire and also strengthens the wire to accommodate spasms occurringin the vessel. The coating 87 (and 287, 387) also blocks the intersticesof the coil 90 to provide a less abrasive surface. The various coatingand/or jackets and/or shrink wrap can be made of PET, Teflon, Pebax,polyurethane or other polymeric materials. The material helps to preventthe native vessel from being caught in the coil 90 and reduces vesselspasms.

In use, which by way of example is shown and described with respect tothe embodiment of FIGS. 1-5 but the other wires described herein wouldbe used in the same fashion, an access sheath S is inserted into thevessel over a guidewire G in the femoral artery F and located viaimaging. The sheath S is advanced to the desired site through thevascular system into the cerebral arteries A, and into the Circle ofWillis C (see FIGS. 10-12). Once at the site, the guidewire G iswithdrawn and the thrombectomy apparatus 10 is inserted through thesheath S (FIG. 13). An introducer tube can be utilized, placed into aproximal end of the sheath S to facilitate introduction of the wire 30through the sheath S. Once the distal end of the wire is at the siteexposed from the sheath (see FIG. 14) switch 58 on housing 12 isactuated to turn on the motor thereby causing wire 30 to rotate aboutits longitudinal axis. The knob 57 can be turned to dial up the motorspeed. Note that if non-linear tip wires are utilized such as wires 360or 260 of FIGS. 6, and 7, when exposed as in the position of FIG. 14,they would move to their non-linear configuration, i.e. J-shape orsinuous shape, respectively.

It should be appreciated that if a user attachable wire connection isutilized, after the position of FIG. 13 or FIG. 14, a motor housingcould be connected to the wire to operatively couple the proximal end ofthe wire to the motor as described above. In the illustration of FIGS.13 and 14, the motor housing is already attached, either by theattachable connection as described above or due to the housing and wireprovided as a single already connected assembly which may benon-detachable.

The introducer sheath can optionally have side ports for aspirating thesmall particles macerated by the thrombectomy wires described herein.

Note the apparatus could include a sheath connected to the housing asdescribed above so that the method would include the additional step ofrelative movement of the wire and sheath to expose the wire within thevessel.

A delivery sheath can be provided which includes a balloon to blockblood flow and allow aspiration in the blocked space.

While the above description contains many specifics, those specificsshould not be construed as limitations on the scope of the disclosure,but merely as exemplifications of preferred embodiments thereof. Thoseskilled in the art will envision many other possible variations that arewithin the scope and spirit of the disclosure as defined by the claimsappended hereto.

What is claimed is:
 1. A method for removing thrombus in a cerebralartery of a patient comprising: introducing a guidewire into the femoralartery; inserting the guidewire through a vascular system into thecerebral artery; inserting a catheter tube over the guidewire into thecerebral artery; removing the guidewire; placing an introducer at theproximal end of the catheter tube; inserting a thrombectomy wire throughthe introducer and into the catheter tube, the thrombectomy wire havinga core and a component positioned over the core, the component spacedproximally from a distalmost tip of the thrombectomy wire to increase adiameter of the thrombectomy wire in a region spaced from the distalmosttip to increase torsional stiffness of the thrombectomy wire forpushability to the cerebral artery; inserting the thrombectomy wire intothe vascular system; advancing the thrombectomy wire to the cerebralartery; operatively connecting the thrombectomy wire to a motor afterinsertion of the thrombectomy wire into the vascular system, the step ofconnecting the thrombectomy wire performed by a clinician; andactivating the motor to rotate the thrombectomy wire to maceratethrombus in the cerebral artery.
 2. The method of claim 1, wherein thestep of advancing the thrombectomy wire to the cerebral artery includesthe step of inserting the thrombectomy wire into a circle of Willis. 3.The method of claim 1, wherein exposure of the thrombectomy wire fromthe catheter tube enables a distal portion of the thrombectomy wire tomove to a non-linear configuration.
 4. The method of claim 3, whereinthe non-linear configuration is a substantially sinuous shape.
 5. Themethod of claim 1, wherein the thrombectomy wire is operativelyconnected to the motor by a clinician prior to advancement of thethrombectomy wire to the cerebral artery.
 6. The method of claim 1,wherein the thrombectomy wire is detachably operatively connected to themotor.
 7. A method for removing thrombus in a target artery of a patientcomprising: inserting a guidewire through a vascular system to thetarget artery; inserting a member having a lumen over the guidewire intothe target artery; removing the guidewire; inserting a thrombectomy wirethrough the member, the thrombectomy wire unattached to a motor duringinsertion; exposing a distal portion of the thrombectomy wire in thetarget artery; operatively connecting a proximal portion of thethrombectomy wire to a motor prior to activating the motor andsubsequent to insertion of the thrombectomy wire into the vascularsystem; and activating the motor after operative connection of thethrombectomy wire to rotate the thrombectomy wire to macerate thrombusin the target artery.
 8. The method of claim 7, wherein the targetartery is a cerebral artery such that the step of inserting thethrombectomy wire to the target artery includes the step of insertingthe thrombectomy wire into the cerebral artery.
 9. The method of claim8, wherein the step of inserting the thrombectomy wire into the cerebralartery includes the step of inserting the thrombectomy wire into acircle of Willis.
 10. The method of claim 8, wherein exposure of thethrombectomy wire from the member enables a tip of the thrombectomy wireto move to a non-linear configuration.
 11. The method of claim 10,wherein the non-linear configuration is a substantially sinuous shape.12. The method of claim 7, wherein the step of operatively connecting aproximal portion of the thrombectomy wire to the motor includes the stepof frictionally engaging a housing of the motor.
 13. The method of claim7, wherein the step of operatively coupling a proximal portion of thethrombectomy wire to the motor includes the step of rotation in abayonet type mount to a housing of the motor.
 14. The method of claim 7,wherein the thrombectomy wire is detachably operatively connected to themotor.